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There is a NEW 24 hour ER on right hand side of 441 as your heading north just before Marion Market. Might want to give them a try.

[dbussone]

Originally Posted by Hancle704

It was not too long ago that TVRH opened an Urgent Care Office in the building on the east side of Hwy 27/441. They have since moved it to the first floor of the hospital. Maybe it is time for management to consider turning it into a 24/7 facility to help relieve the burden on the hospital's emergency department, especially during peak season.

As things stand now not everyone who arrives at the hospital is transported by ambulance or requires the services of the ED.

Many well run ERs do exactly what you are suggesting - having an urgent care operation in, or close to, the ER. They typically operate 24/7 and function to fast track non-urgent patients.


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[dbussone]

Originally Posted by golfing eagles

I agree with you to a point, the failure of management is in not CORRECTING the problem. The board is not down in the ER doing the work, but they are responsible for oversight

Each ER seems to have it's own "culture", and as someone put it, I have had "firsthand" experience with 20 or 30 of them. If the people in charge are laid back and have low expectations, it carries through all the staff. Sometimes there are people there for 20 or 30 years that defacto run the show THEIR way, and are reticent to change. This problem came up when I ran the QA committee, was chief of staff and sat on the board, so here is what we did:



1) We designated 5 rooms as fast track/urgent care with a good NP in charge and triaged appropriate cases in that direction.



2) We looked at ambulance arrivals. There are people who call an ambulance for no good reason at all. About 85% of this was because car service cost $5 but the ambulance was free (to THEM, $800 for the taxpayer to fork up). The other 15% was due to the belief they could bypass the waiting room. So we started a policy that non-emergent ambulance arrivals would be triaged to the WAITING ROOM, and usually to urgent care from there, thus removing some incentive.



3) Often there are patients who are getting admitted, but were waiting to be seen by the hospitalist or attending. We made a policy that the attending had 30 minutes to see the patient in the ER, otherwise they would be sent to their floor with just a few holding orders. The floor nurses would bug them from there. This freed up many ER rooms to move patients along.



4) We overrode a nursing policy that stated no patient would be accepted to a floor for 45 min before and after a shift change. This was 4 1/2 hours each day during which no patient could be moved out of the ER. This was accomplished by staggering shifts and mixing in 12 hour shifts for those who wanted them



5) We started much more extensive tracking of ER times, from triage to nursing assessment, physician contact, lab and x-ray being performed and admitting physician writing orders. We put a big LED TV over the ER desk with the initials of each patient in each room, their preliminary diagnosis, and the arrival time. Any time more than 25 minutes passed between steps that room was highlighted



6) we put in loud and annoying call bells in each ER room that could only be turned off from within the room



7) we gave out patient satisfaction forms to every patient and family asking them to be explicit about their experience



8) We identified the slowest and laziest worker on each shift and found them a more appropriate position elsewhere. The message was clearly sent.



Bottom line, within 4 months waiting time was cut in half and was less than the national average, and patient satisfaction went from 4.6 to 8.9 (out of 10).



So it can be done. TVRH ER may have some slightly different problems, but wait time everywhere is related to volume, staffing, and patient flow. So why hasn't this problem been addressed long ago, that's the real question.

GolfingEagles has just noted many suggestions that really can make a difference in improving ER performance.

I'll add another. In 4 or 5 poorly performing ERs, I've changed out the group of physicians providing care in an ER. Physicians who are lazy or have a poor attitude bleed these traits to the entire department. A change in a physician, or the entire group of physicians, is sometimes necessary and can generate a huge performance boost.

My observations tell me TVRH has several problems in this area, including not properly matching patient influx and physician staffing. Physician attitudes are another. The ER physicians do not seem to be patient oriented, preferring to spend most of their time at a nurses station rather than with patients. Just my observations.


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[golfing eagles]

Originally Posted by dbussone

GolfingEagles has just noted many suggestions that really can make a difference in improving ER performance.

I'll add another. In 4 or 5 poorly performing ERs, I've changed out the group of physicians providing care in an ER. Physicians who are lazy or have a poor attitude bleed these traits to the entire department. A change in a physician, or the entire group of physicians, is sometimes necessary and can generate a huge performance boost.

My observations tell me TVRH has several problems in this area, including not properly matching patient influx and physician staffing. Physician attitudes are another. The ER physicians do not seem to be patient oriented, preferring to spend most of their time at a nurses station rather than with patients. Just my observations.


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I agree with you, and saw the same thing when my wife was there. I just don't know if a complete housecleaning is needed. What type of physician ER staffing currently exists? Are they hospital employees or a subcontracted group?
We didn't have this problem back in 2001 since we had a stable ER physician staff that was there 20 years. But 10 years later, most of them were gone, and we looked into a national staffing group and eventually contracted with one. The problem is that the presentation is usually given by a Harvard graduate, trained at Mass General, with a supposed staff of all American University trained ER docs. It starts off that way, but 3-6 months later, one by one, those docs are replaced with FMGs, many who have yet to master English as a second language. I suspect there is a physician recruitment/retention problem in Central Florida.

[ortman118]

We also had a horrible experience at the ER. In March of last year I took my husband who was in great pain from a kidneystone to the ER around 6PM. He was triaged and then we sat with a plastic bucket for his vomiting for 4 hours in the waiting room. We left and went home with him never being seen and after others there told us they had been waiting 8 hours. He passed the kidney stone at home later that night. We received a bill for $392.40. Same explanation given to us as you. When we complained about the extensive wait the response was "well we are pretty busy during snowbird season". So unless we have an emergency during off season we will head to Leesburg ER. It really galls me to read the accolades in the newspaper on how great the ER is.

[golfing eagles]

Originally Posted by ortman118

We also had a horrible experience at the ER. In March of last year I took my husband who was in great pain from a kidneystone to the ER around 6PM. He was triaged and then we sat with a plastic bucket for his vomiting for 4 hours in the waiting room. We left and went home with him never being seen and after others there told us they had been waiting 8 hours. He passed the kidney stone at home later that night. We received a bill for $392.40. Same explanation given to us as you. When we complained about the extensive wait the response was "well we are pretty busy during snowbird season". So unless we have an emergency during off season we will head to Leesburg ER. It really galls me to read the accolades in the newspaper on how great the ER is.

And there is just no excuse for that. Just get him in a room, start an IV, get a urine and abdominal flat plate, and shoot him up with IV Zofran and morphine. Shouldn't take more than 20 minutes.
I do appreciate the staffing issues that arise when the service population goes from 80,000 to 130,000 virtually overnight, but that is administration's problem, it shouldn't be the patient's. If the ER rooms are backed up because of patients waiting to go to a floor, implement the suggestions I made above.
I agree with Db, there may be a laziness factor in play. An ER room filled with a patient just waiting to go upstairs is almost no work; putting a new patient in there is a lot of work. Also, ER staff tend to have a shift mentality, if they can make it to next shift it's not their problem any more. That needs to change.
Also this is the 3rd or 4th post about patients sitting in the waiting room and given a bucket to vomit into. Horrible. Administration needs to realize that right or wrong, the ER is the "face" of the hospital to most of the community. I would never tolerate that in any ER I was running, the nice nurse who posted above wouldn't tolerate it, and I don't think the patient population should either. No one in pain EVER wants to hear "we're busy".

[NotGolfer]

I wonder "IF" everyone whose had a bad experience or less than good, who have posted here all e-mail the hospital (or snailmail) and call the administration along with that with their complaints "IF" they'd begin making changes. I know that "some" of the medical staff at the ER are "traveling" contracted employees and don't even live in this area. This I know from personal contact/experience of being both in the ER and later admitted to a room on the floor.

I also know that in the past 6 to 8 mo. TVRH has changed out their procedure of patients. Unless it's an extreme emergency...even if brought in via ambulance...they will send their patients out to the waiting room. I agree this probably isn't the best way of doing things. The waiting room is right next to the front door with windows and it's not a great 1st impression (someone else stated this already). How about having the waiting-room on the other side, separate from the front entry??

[golfing eagles]

Originally Posted by NotGolfer

I wonder "IF" everyone whose had a bad experience or less than good, who have posted here all e-mail the hospital (or snailmail) and call the administration along with that with their complaints "IF" they'd begin making changes. I know that "some" of the medical staff at the ER are "traveling" contracted employees and don't even live in this area. This I know from personal contact/experience of being both in the ER and later admitted to a room on the floor.

I also know that in the past 6 to 8 mo. TVRH has changed out their procedure of patients. Unless it's an extreme emergency...even if brought in via ambulance...they will send their patients out to the waiting room. I agree this probably isn't the best way of doing things. The waiting room is right next to the front door with windows and it's not a great 1st impression (someone else stated this already). How about having the waiting-room on the other side, separate from the front entry??

Actually, it would be better to fix the problems and put their well run ER on display in the window than simply hide the problems in a back room. The "traveling" doctors are what is called locum tenens, usually a 3 month contract in a given location. Not the best in general, no roots in the community, and very costly since they are hired through a third party which bills them out at double or triple to going rate. Also, sending everything but dire emergencies to the waiting room is too much of a good thing. They need to send sore throats, earaches, rashes, toothaches and the like there, or to urgent care, but not people in significant pain, vomiting into a bucket and certainly not chest pain as someone posted about 6 months ago. Again, it makes me believe the ER exam rooms are blocked by patients awaiting admission or extremely slow assessments in the ER. As far as administration goes, I can't believe they are unaware of the problems, but likewise I can't believe they don't know how to fix them. I'm afraid that sooner or later they are going to have a medical disaster (which usually involves an illegal immigrant pregnant woman, just as it did in Texas prior to the COBRA act of 1997) that gains media attention and then they'll have real problems

[dbussone]

Originally Posted by golfing eagles

And there is just no excuse for that. Just get him in a room, start an IV, get a urine and abdominal flat plate, and shoot him up with IV Zofran and morphine. Shouldn't take more than 20 minutes.

I do appreciate the staffing issues that arise when the service population goes from 80,000 to 130,000 virtually overnight, but that is administration's problem, it shouldn't be the patient's. If the ER rooms are backed up because of patients waiting to go to a floor, implement the suggestions I made above.

I agree with Db, there may be a laziness factor in play. An ER room filled with a patient just waiting to go upstairs is almost no work; putting a new patient in there is a lot of work. Also, ER staff tend to have a shift mentality, if they can make it to next shift it's not their problem any more. That needs to change.

Also this is the 3rd or 4th post about patients sitting in the waiting room and given a bucket to vomit into. Horrible. Administration needs to realize that right or wrong, the ER is the "face" of the hospital to most of the community. I would never tolerate that in any ER I was running, the nice nurse who posted above wouldn't tolerate it, and I don't think the patient population should either. No one in pain EVER wants to hear "we're busy".

Over a couple of years, for visits involving my wife, I have made suggestions to administration about the ER and my perceptions on areas needing improvement. Our personal physician has commented to administration, and my wife's orthopaedist personally talked with the highest level of administration. He was a Chief of Staff at the time.


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[dbussone]

Originally Posted by golfing eagles

And there is just no excuse for that. Just get him in a room, start an IV, get a urine and abdominal flat plate, and shoot him up with IV Zofran and morphine. Shouldn't take more than 20 minutes.

I do appreciate the staffing issues that arise when the service population goes from 80,000 to 130,000 virtually overnight, but that is administration's problem, it shouldn't be the patient's. If the ER rooms are backed up because of patients waiting to go to a floor, implement the suggestions I made above.

I agree with Db, there may be a laziness factor in play. An ER room filled with a patient just waiting to go upstairs is almost no work; putting a new patient in there is a lot of work. Also, ER staff tend to have a shift mentality, if they can make it to next shift it's not their problem any more. That needs to change.

Also this is the 3rd or 4th post about patients sitting in the waiting room and given a bucket to vomit into. Horrible. Administration needs to realize that right or wrong, the ER is the "face" of the hospital to most of the community. I would never tolerate that in any ER I was running, the nice nurse who posted above wouldn't tolerate it, and I don't think the patient population should either. No one in pain EVER wants to hear "we're busy".

Remember when the new ER was going to be the solution to all the the problems of the then current ER? I stated then that architecture seldom resolves all those issues. The physicians, IMHO, were the bottleneck at that time and probably remain so.

So, why are patients being dumped into the ER with all the grand new space available? And is the holding area for those waiting for inpatient rooms being used? (Usually this just results in patients being held in the ER longer, as GE has pointed out.)

Current practice in hospital design eliminates the large nursing stations and creates smaller distributed staff work stations for 2-3 people. This keeps docs and staff moving around to keep them closer to patients.

The ER physician group, unless it has changed recently, is based out of the Ft. Lauderdale area. It relies heavily on Locum Tenens physicians. I terminated their contract at one hospital in the late '90s.




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[dbussone]

Originally Posted by golfing eagles

Actually, it would be better to fix the problems and put their well run ER on display in the window than simply hide the problems in a back room. The "traveling" doctors are what is called locum tenens, usually a 3 month contract in a given location. Not the best in general, no roots in the community, and very costly since they are hired through a third party which bills them out at double or triple to going rate. Also, sending everything but dire emergencies to the waiting room is too much of a good thing. They need to send sore throats, earaches, rashes, toothaches and the like there, or to urgent care, but not people in significant pain, vomiting into a bucket and certainly not chest pain as someone posted about 6 months ago. Again, it makes me believe the ER exam rooms are blocked by patients awaiting admission or extremely slow assessments in the ER. As far as administration goes, I can't believe they are unaware of the problems, but likewise I can't believe they don't know how to fix them. I'm afraid that sooner or later they are going to have a medical disaster (which usually involves an illegal immigrant pregnant woman, just as it did in Texas prior to the COBRA act of 1997) that gains media attention and then they'll have real problems

[emoji106][emoji106]


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My husband was taken by ambulance to the ER on Sunday for chest pain and he was assessed and treated quickly. From what I could observe the biggest problem there is volume. They had more patients than they had rooms for and some were waiting in the hallway for a room. When he was finally admitted the hospital itself was full and he had to wait 6 hours for a bed. His treatment however was excellent. The nurses were straight out but still gave us wonderful care. Today they told us that they had 4 heart attacks in one day and heart attacks always get moved to the front of the line. I am sure if we had gone in for kidney stones it would have been a different story but that is how it works. Life threatening conditions always go first and in The Villages there is always an abundance.

[Hancle704]

Wife was recently brought to TVRH by ambulance. Waiting room was not too crowded. Brought to room in new part of Emergency Dept Had a great nurse for initial shift. Then she spent over 24 hours in bed in ED before bed became available in Cardiac Section of 4th floor. Meanwhile the crowds built up in ED waiting area to be seen and brought in for tests and treatment. Some are parked on gurneys in hallways as there are no ER beds/Rooms available

So it starts with bottleneck in ED and that spreads. Because there is no staff till next shift or later for rooms.. One thing seems certain, it's bad now and it will be worse in the following years as population increases. Recent additions to hospital have not fixed the problem of inadequate staffing, long waits in waiting room and longer waits to be admitted and brought to room.

[KYDIANA12]

I recently went to the Leesburg ER and was very impressed with their service and care. They followed up with a survey in the mail to see how I ranked their care. I gave them very high marks and would definitely go back there.

[ronsroni]

In most cases of "waiting an eternity", I recognize that 'eternity' can be as short as 20 minutes. That said, when one is in pain; agonizing PAIN', 5 minutes can be an eternity.
Sadly, I honestly can see someone waiting upwards of 15 hours to be evaluated; forget about treated. My dear friend got to TVH-ED after experiencing what he thought were heart attack symptoms. He complained of chest pains upon his arrival there at 10:45PM. He sat in chairs till 11:25PM and was taken back to a room. Clutching at his chest continued and he yelled out for help. He said a Dr????" stuck his head in and said he was sending help.
At 1:45AM, he was visited by a CNA and vitals were done. Pain level at that point was a 7-8. Improved but he was tachy (tachycardia- fast heart rate) and sweating. No IV line. CHEST PAINS, DIAPHORESIS (excessive sweating).
NO O2 was placed. No LABS!!!
At 3:30AM, he got to his feet and headed for the exit. He collapsed in the lobby; passed out.
He was brought back to the room, had a CXR and WAITED till 4:15AM for labs and a room. His temp at that point was 103.8 and climbing. He was taken to the OR at 1PM and had his abscessed gallbladder (never had a symptom before) removed. Shocker here, infection followed. So, to wonder if someone really waited that long' it pains me to say yes, I can believe it. It is terrifying.
I, typically, give time estimates a pass. My time is different from your time in urgent situations sometimes. Horrific care is just that.
I use Santa Barbara United Healthcare and I have been thrilled. Yes, I am very observant and I ask questions. Some folks, especially elders, are trusting of the people who hold their life in their hands. Respect. Tough to change an entire lifes behavior that readily.
I just hope that the care there improves. It will never be a Level 1. It NEEDS improvement. NOMESAYIN??